MEDICARE: DIANE MARIE YAMAMOTO SKOWRON PHARMD, CCH, CH, CI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175L00000X	Homeopath		CA
2	1835N1003X	Nutrition Support Pharmacist	43278	CA
3	1835P1200X	Pharmacotherapy Pharmacist	43278	CA

General Provider Information

NPI Number	:	1205918778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE MARIE YAMAMOTO SKOWRON PHARMD, CCH, CH, CI

Provider Business Mailing Address
First Line	:	1505 N EDGEMONT ST
Second Line	:	PHARMACY
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5209
Country	:	US
Telephone Number	:	323-783-4148
Fax Number	:	323-783-5694

Provider Business Practice Location Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-860-5200
Fax Number	:	323-722-8040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	05/02/2019

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